Like so many in Gaza, Eid al-Attar, a teacher from the north of the territory, now spends his days trying to find enough food and water to keep his family alive. Displaced eight times since the war between Israel and Hamas broke out in October, the 42-year-old has tried his best to shield his five children from the conflict. Now the Palestinian territory is facing a new danger: the highly infectious and potentially deadly disease, polio.
“We cannot protect our children. We are exposed to death at any moment due to the constant bombardment and insecurity. And I cannot protect them from diseases either,” he said in Deir al-Balah on Sunday as a UN-led vaccination campaign got under way.
“We live in a tent, which does not protect us from anything, there are no medicines, there is garbage everywhere, and the streets are filled with wastewater.”
Israel’s bombing campaign in Gaza has decimated the territory’s healthcare system, with 31 of 36 hospitals damaged or destroyed, according to the World Health Organization. About 90% of the 2.3 million people who live in the Gaza Strip have been displaced from their homes, with the majority living in very overcrowded, unsanitary makeshift camps. Hepatitis, pneumonia and diarrheal diseases such as dysentery, as well as scabies, lice and debilitating rashes are already rife, the WHO said.
The number of deaths caused by illness of more than 40,000 casualties recorded by the health ministry in the Hamas-controlled territory is unclear. But one of healthcare workers’ worst fears were confirmed last week when Gaza recorded its first case of type 2 polio in a quarter century. The contagious disease can cause paralysis and death, particularly in infants and young children.
Polio was eradicated from the Gaza Strip in 1999, but a strain was detected in routine wastewater testing in July. It is believed to have come from an oral polio vaccine, which contains a weakened live virus, and can in rare cases be shed by vaccinated people and evolve into a new, contagious form.
The first case was reported last week in a 10-month-old boy, who is paralysed in one leg. He did not receive any routine childhood vaccinations because of the war. According to the WHO, hundreds more people are probably already infected, but not showing symptoms, putting hundreds of thousands of children in Gaza at risk.
An incredibly complex vaccination drive led by the UN and local health authorities is now under way to prevent the re-emergence of polio among a new generation.
At least 90% of Gaza’s 640,000 children under 10 must be vaccinated with two drops of oral vaccine in two rounds, four weeks apart, to prevent the disease from spreading – a formidable goal in an active war zone where conditions can change rapidly.
Hamas and Israel have agreed to humanitarian pauses in fighting between 6am and 3pm for the next few days during which vaccination teams aim to visit 160 sites, beginning in central Gaza before travelling to harder-to-reach areas. Damaged or destroyed roads make it difficult for healthcare workers to move around, and aid workers and shipments have been hit by Israeli bombings.
Four people were killed in an Israeli airstrike last week that hit the front of a convoy carrying food and fuel to a hospital in Rafah, the American Near East Refugee Aid (Anera) group said. Israel said it had targeted gunmen who seized the convoy, although Anera and witnesses denied that any armed fighters were in the area.
Israel allowed about 1.3m doses to be brought into Gaza last month, which are now being held in refrigerated storage in a warehouse in the central town of Deir al-Balah. Another shipment of 400,000 doses is expected to arrive in the territory soon.
“Israel views with importance the prevention of a polio outbreak in the Gaza Strip, including for the purpose of preventing the spread of diseases in the region”, the Israeli prime minister, Benjamin Netanyahu, said in a statement last week.
Fuel shortages make powering the generators that keep the vaccinations cool another major struggle, since existing cold chain storage facilities have all been destroyed. Dr Khalil Abu Qasmiya, the director of the health ministry in Deir al-Balah, said he and his team are waking up at regular intervals in the night to check that the fridge temperatures are stable and ice packs have not melted. “Since the first case of polio appeared, the ministry of health has bent over backwards to do our part,” he said.
Unlike many other international efforts to alleviate the suffering in Gaza, the polio vaccine rollout is so far going smoothly: 72,600 children were vaccinated on the operation’s first day, the Gaza health ministry said. It is also hoped that the efforts made to repair the cold chain system would allow routine immunisations to begin once the polio campaign was completed.
Nabil al-Hasanat, 50, a father of two girls, aged six and five months, said: “We are all suffering a lot. I am glad I can do one thing to protect my children.”
The underlying humanitarian crisis remains, however, with no sign of a breakthrough in ceasefire talks soon.
Jose Lainez Kafati, a social and behaviour change specialist at Unicef Palestine, said: “Polio is just one of the many problems the children of Gaza are facing.
“While we have managed to start the polio vaccination, there are other serious problems that are still unattended by the lack of access to aid. The total breakdown of the healthcare system, the almost complete destruction of sanitation and water infrastructure, as well as the living conditions of families who no longer have a home, makes them vulnerable to other disease outbreaks.”
